Food insecurity linked to HIV-treated drug users’ deaths

Food insecurity increases the risk of death among injection drug users living with HIV/AIDS even when they are receiving life-prolonging antiretroviral therapy (ART), according to a new study involving Simon Fraser University.

The study, recently published in the peer-reviewed science journal, PLOS ONE, examines the impact of food insecurity and hunger on survival among injection drug users. Food insecurity is defined by the United Nations’ World Food Programme as having insufficient access to adequate quantity and quality of food. Researchers found that drug users who were food insecure when first initiating ART were twice as likely to die compared to individuals who were food secure.

“This is the first study to look at the impact of food insecurity on the survival of HIV-positive injection drug users,” says senior author Robert Hogg, an SFU health sciences professor and director of the HIV/AIDS Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS (BC-CfE).

“The introduction of life-saving antiretroviral therapy has significantly reduced HIV-related morbidity and mortality, however, the impact of insufficient access to food, particularly quality food, on the mortality of HIV-positive injection drug users is alarming. This research points to the urgent need to further investigate the impact of food insecurity on the health outcomes of people living with HIV/AIDS.”

Researchers followed 254 injection drug users across B.C., finding that 71 per cent of them reported being food insecure at the time of ART initiation. After 13 years of follow-up, drug users who were food insecure were twice as likely to die compared to individuals who were food secure. Sub-analyses found hunger, or food insufficiency, was not the primary cause of mortality in this population.

“Findings regarding the relationship between food insecurity and mortality are particularly relevant to community organizations working in Vancouver’s Downtown Eastside, the epicentre of drug use in Canada,” says Brian Chittock. He is a co-principal investigator on the national HIV food security study and executive director of AIDS Vancouver.

“The findings speak to the need to explore options for improving the quality of foods available to residents. Further, the results suggest drug users would benefit from improved access to education and counselling around healthy eating, nutritional screening and referral for appropriate clinical care.”

“Our work has international implications as it highlights the importance of food security for the sustained survival of HIV-positive people not just here in B.C., but in other parts of the world,” says Aranka Anema. She is the first author on this study and a BC-CfE epidemiologist.

“We are collaborating with the United Nations World Food Program and other international agencies to identify evidence-based practices and policies for the prevention and management of food insecurity among people living with HIV/AIDS.”

Simon Fraser University is Canada's top-ranked comprehensive university and one of the top 50 universities in the world under 50 years old. With campuses in Vancouver, Burnaby and Surrey, B.C., SFU engages actively with the community in its research and teaching, delivers almost 150 programs to more than 30,000 students, and has more than 120,000 alumni in 130 countries.

Since implementing the BC-CfE-pioneered Treatment as Prevention strategy, B.C. has witnessed a marked decrease in morbidity, mortality and new HIV cases. The strategy involves widespread HIV testing and provision of highly active antiretroviral therapy (HAART) to people with HIV.

At the height of the epidemic in the early 1990s, the number of new HIV diagnoses was more than 800 a year. In 2012, the number of new HIV diagnoses had dropped to 238, and HIV-related morbidity and mortality have decreased by approximately 90 per cent over the same period. The new research suggests food supplementation and socio-structural supports for injection drug users could reduce HIV-related mortality even further.

The BC-CfE has teamed up with two major AIDS service organizations (ASOs) in B.C., AIDS Vancouver and the Pacific AIDS Network, to work on an innovative national study funded by the Canadian Institutes of Health Research. This study involves 30 ASOs and four universities and will seek to understand the prevalence and impacts of food insecurity on the health of people living with HIV/AIDS across Canada.

About the British Columbia Centre for Excellence in HIV/AIDS

The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases.

BC-CfE is based at St. Paul’s Hospital, Providence Health Care — a teaching hospital of the University of British Columbia. The BC-CfE works in close collaboration with key provincial stakeholders, including health authorities, health care providers, academics from other institutions, and the community to decrease the health burden of HIV and AIDS. By developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses, the BC-CfE helps improve the health of British Columbians living with HIV.